Abstract：
BACKGROUND: Total thyroidectomy (TTx) has been reported to be more challenging in patients with Graves\' disease, especially in those who are hyperthyroid at the time of surgery. Our aim was to compare outcomes in patients undergoing TTx for Graves\' disease compared to other thyroid diseases at a large academic institution with high-volume fellowship-trained endocrine surgeons.
METHODS: In our retrospective analysis from December 2015 to May 2023, patients undergoing TTx for Graves\' disease were compared to those undergoing TTx for all other indications excluding advanced malignancy (poorly differentiated thyroid cancer and concomitant neck dissections). Patient demographics, biochemical values, and postoperative outcomes were compared. A subgroup analysis was performed comparing hyperthyroid to euthyroid patients at the time of surgery.
RESULTS: There were 589 patients who underwent TTx, of which 227 (38.5%) had Graves\' disease compared to 362 (61.5%) without. Intraoperatively in Graves\' patients, nerve monitoring was used more frequently (65.6% versus 57.1%; P = 0.04) and there was a higher rate of parathyroid autotransplantation (32.0% versus 14.4%; P < 0.01). Postoperatively, transient voice hoarseness occurred less frequently (4.8% versus 13.6%; P < 0.01) and there was no difference in temporary hypocalcemia rates or hematoma rates. In our subgroup analysis, 83 (36%) of Graves\' patients were hyperthyroid (thyroid-stimulating hormone < 0.45 and free T4 > 1.64) at the time of surgery and there were no differences in postoperative complications compared to those who were euthyroid.
CONCLUSIONS: At a high-volume endocrine surgery center, TTx for Graves\' disease can be performed safely without significant differences in postoperative outcomes. Hyperthyroid patients demonstrated no differences in postoperative outcomes.
METHODS: In our retrospective analysis from December 2015 to May 2023, patients undergoing TTx for Graves\' disease were compared to those undergoing TTx for all other indications excluding advanced malignancy (poorly differentiated thyroid cancer and concomitant neck dissections). Patient demographics, biochemical values, and postoperative outcomes were compared. A subgroup analysis was performed comparing hyperthyroid to euthyroid patients at the time of surgery.
RESULTS: There were 589 patients who underwent TTx, of which 227 (38.5%) had Graves\' disease compared to 362 (61.5%) without. Intraoperatively in Graves\' patients, nerve monitoring was used more frequently (65.6% versus 57.1%; P = 0.04) and there was a higher rate of parathyroid autotransplantation (32.0% versus 14.4%; P < 0.01). Postoperatively, transient voice hoarseness occurred less frequently (4.8% versus 13.6%; P < 0.01) and there was no difference in temporary hypocalcemia rates or hematoma rates. In our subgroup analysis, 83 (36%) of Graves\' patients were hyperthyroid (thyroid-stimulating hormone < 0.45 and free T4 > 1.64) at the time of surgery and there were no differences in postoperative complications compared to those who were euthyroid.
CONCLUSIONS: At a high-volume endocrine surgery center, TTx for Graves\' disease can be performed safely without significant differences in postoperative outcomes. Hyperthyroid patients demonstrated no differences in postoperative outcomes.
摘要：
背景：据报道，甲状腺全切除术（TTx）在患有Graves病的患者中更具挑战性，尤其是那些在手术时甲状腺功能亢进的人。我们的目的是比较接受Graves病TTx治疗的患者与其他甲状腺疾病患者的结局，该机构拥有经过大量研究金培训的内分泌外科医生。
方法：在我们2015年12月至2023年5月的回顾性分析中，将接受Graves病TTx的患者与接受TTx治疗的患者的所有其他适应症（不包括晚期恶性肿瘤（低分化甲状腺癌和合并颈部淋巴结清扫术）。患者人口统计学，生化值，和术后结局进行比较。进行了亚组分析，比较了手术时甲状腺功能亢进与甲状腺功能正常的患者。
结果：有589例患者接受了TTx，其中227人（38.5%）患有格雷夫斯病，而362人（61.5%）没有。Graves\'患者的术中，神经监测的使用频率更高(65.6%vs57.1%;P=0.04),甲状旁腺自体移植的发生率更高(32.0%vs14.4%;P<0.01).术后,短暂性声音嘶哑发生率较低(4.8%对13.6%;P<0.01),暂时性低钙血症或血肿发生率无差异.在我们的亚组分析中，83例（36%）Graves患者在手术时甲状腺功能亢进（促甲状腺激素<0.45，游离T4>1.64），术后并发症与甲状腺功能正常者相比无差异。
结论：在一个高容量的内分泌手术中心，Graves病的TTx可以安全地进行，术后结局没有显着差异。甲状腺功能亢进患者的术后结局无差异。
方法：在我们2015年12月至2023年5月的回顾性分析中，将接受Graves病TTx的患者与接受TTx治疗的患者的所有其他适应症（不包括晚期恶性肿瘤（低分化甲状腺癌和合并颈部淋巴结清扫术）。患者人口统计学，生化值，和术后结局进行比较。进行了亚组分析，比较了手术时甲状腺功能亢进与甲状腺功能正常的患者。
结果：有589例患者接受了TTx，其中227人（38.5%）患有格雷夫斯病，而362人（61.5%）没有。Graves\'患者的术中，神经监测的使用频率更高(65.6%vs57.1%;P=0.04),甲状旁腺自体移植的发生率更高(32.0%vs14.4%;P<0.01).术后,短暂性声音嘶哑发生率较低(4.8%对13.6%;P<0.01),暂时性低钙血症或血肿发生率无差异.在我们的亚组分析中，83例（36%）Graves患者在手术时甲状腺功能亢进（促甲状腺激素<0.45，游离T4>1.64），术后并发症与甲状腺功能正常者相比无差异。
结论：在一个高容量的内分泌手术中心，Graves病的TTx可以安全地进行，术后结局没有显着差异。甲状腺功能亢进患者的术后结局无差异。
